" In 2017, there were 70,237 drug overdose deaths in the United States.

" The age-adjusted rate of drug overdose deaths in 2017 (21.7 per 100,000) was 9.6% higher than the rate in 2016 (19.8).

" Adults aged 25–34, 35–44, and 45–54 had higher rates of drug overdose deaths in 2017 than those aged 15–24, 55–64, and 65 and over.

" West Virginia (57.8 per 100,000), Ohio (46.3), Pennsylvania (44.3), and the District of Columbia (44.0) had the highest age-adjusted drug overdose death rates in 2017.

" The age-adjusted rate of drug overdose deaths involving synthetic opioids other than methadone (drugs such as fentanyl, fentanyl analogs, and tramadol) increased by 45% between 2016 and 2017, from 6.2 to 9.0 per 100,000."

According to the Centers for Disease Control, using data available for analysis on September 5, 2018, there were a reported 70,652 deaths attributed to drug overdose in the US for the year ending December 2017. Some deaths were still under investigation. The CDC projects that the total for 2017 will be 72,222.

Of these:
Opioids were detected in 47,863 reported deaths, and are predicted to be involved in 49,031 deaths.
Synthetic opioids, excluding methadone, were detected in 28,644 reported deaths, and are predicted to be involved in 28,644 deaths.
Heroin was detected in 15,585 reported deaths, and is predicted to be involved in 15,941 deaths.
Natural and semi-synthetic opioids were detected in 14,553 reported deaths, and are predicted to be involved in 14,940 deaths.
Cocaine was detected in 14,065 reported deaths, and is predicted to be involved in 14,612 deaths.
Psychostimulants with abuse potential were detected in 10,420 reported deaths, and are predicted to be involved in 10,703 deaths.
Methadone was detected in 3,209 reported deaths, and is predicted to be involved in 3,286 deaths.

Note: Categories are not mutually exclusive because deaths may involve more than one drug.

"The number of drug overdose deaths per year increased 54%, from 41,340 deaths in 2011 to 63,632 deaths in 2016 (Table A). From the literal text analysis, the percentage of drug overdose deaths mentioning at least one specific drug or substance increased from 73% of the deaths in 2011 to 85% of the deaths in 2016. The percentage of drug overdose deaths that mentioned only a drug class but not a specific drug or substance declined from 5.1% of deaths in 2011 to 2.5% in 2016. Review of the literal text for these deaths indicated that the deaths that mentioned only a drug class frequently involved either an opioid or an opiate (ranging from 54% in 2015 to 60% in 2016). The percentage of deaths that did not mention a specific drug or substance or a drug class declined from 22% of drug overdose deaths in 2011 to 13% in 2016."

" The rate of drug overdose deaths involving synthetic opioids other than methadone, which include drugs such as fentanyl, fentanyl analogs, and tramadol, increased from 0.3 per 100,000 in 1999 to 1.0 in 2013, 1.8 in 2014, 3.1 in 2015, 6.2 in 2016, and 9.0 in 2017 (Figure 4). The rate increased on average by 8% per year from 1999 through 2013 and by 71% per year from 2013 through 2017.

" The rate of drug overdose deaths involving heroin increased from 0.7 in 1999 to 1.0 in 2008 to 4.9 in 2016. The rate in 2017 was the same as in 2016 (4.9).

" The rate of drug overdose deaths involving natural and semisynthetic opioids, which include drugs such as oxycodone and hydrocodone, increased from 1.0 in 1999 to 4.4 in 2016. The rate in 2017 was the same as in 2016 (4.4).

" The rate of drug overdose deaths involving methadone increased from 0.3 in 1999 to 1.8 in 2006, then declined to 1.0 in 2016. The rate in 2017 was the same as in 2016 (1.0)."

"The percentage of deaths with concomitant involvement of other drugs varied by drug. For example, almost all drug overdose deaths involving alprazolam or diazepam (96%) mentioned involvement of other drugs. In contrast, 50% of the drug overdose deaths involving methamphetamine, and 69% of the drug overdose deaths involving fentanyl mentioned involvement of one or more other specific drugs.

"Table D shows the most frequent concomitant drug mentions for each of the top 10 drugs involved in drug overdose deaths in 2016.

" Two in five overdose deaths involving cocaine also mentioned fentanyl.

1 Estimated number of deaths annually 2005-2009. U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.2 "Drug" includes both legal and illegal drugs.

4 No recorded cases of overdose deaths from cannabis have been found in extensive literature reviews, see for example Gable, Robert S., "The Toxicity of Recreational Drugs," American Scientist (Research Triangle Park, NC: Sigma Xi, The Scientific Research Society, May-June 2006) Vol. 94, No. 3, p. 207.

6 Paulozzi et al analyzed mortality figures and found that of 38,329 drug overdose deaths then reported in 2010, pharmaceutical drugs accounted for 22,134 deaths, of which 16,651 were opiod analgesic overdoses. The data were apparently revised slightly between the time the research letter was published in JAMA (February 2013) and release of the CDC's Deaths: Final Data for 2010 publication report, officially dated May 8, 2013.7 Hedegaard H, Warner M, Miniño AM. Drug overdose deaths in the United States, 1999–2016. NCHS Data Brief, no 294. Hyattsville, MD: National Center for Health Statistics. 2017.

"During 2015, drug overdoses accounted for 52,404 U.S. deaths, including 33,091 (63.1%) that involved an opioid. There has been progress in preventing methadone deaths, and death rates declined by 9.1%. However, rates of deaths involving other opioids, specifically heroin and synthetic opioids other than methadone (likely driven primarily by illicitly manufactured fentanyl) (2,3), increased sharply overall and across many states."

According to the US Centers for Disease Control, in 2016, there were 63,632 drug overdose deaths in the United States. The CDC further estimates that of those, 42,249 deaths involved any opioid.

The CDC reports that in 2016, 15,469 deaths involved heroin; 14,487 deaths involved natural and semi-synthetic opioids; 3,373 deaths involved methadone; and 19,413 deaths involved synthetic opioids other than methadone, a category which includes fentanyl. The sum of those numbers is greater than the total opioid involved deaths because, as noted by the CDC, "Deaths involving more than one opioid category (e.g., a death involving both methadone and a natural or semisynthetic opioid such as oxycodone) are counted in both categories."

The federal Centers for Disease Control reported on December 21, 2017, that there had been a total of 63,600 deaths attributed to drug overdose in the US in 2016. Based on data available for analysis on Oct. 1, 2017, the CDC's provisional count of drug overdose deaths in the US for the 12-month period ending in December 2016 had been 71,135. The difference is attributed to data quality: provisional counts are by definition incomplete, which means they can be misleading.

The CDC compiles and publishes official data on annual causes of death in the United States. Demand for data on drug overdose deaths, and on drug overdoses generally, is so great that the CDC is now making raw data on these subjects available to the public. Those data are provisional, not final, and so can be misleading. Several caveats that must be understood before examining the numbers. According to the CDC:

"Provisional counts are often incomplete and causes of death may be pending investigation (see table Notes). Data quality measures, such as percent completeness in overall death reporting and percentage of deaths pending investigation, are included to aid interpretation of provisional data, because both data completeness and the percentage of records pending investigation are related to the accuracy of provisional counts (see Technical Notes). Provisional data are based on available records that meet certain data quality criteria at the time of analysis and may not include all deaths that occurred during a given time period. Therefore, they should not be considered comparable with final data and are subject to change. Reporting of specific drugs and drug classes varies by jurisdiction, and comparisons across selected states should not be made (see Technical Notes)."

"First, factors related to death investigation might affect rate estimates involving specific drugs. At autopsy, the substances tested for, and circumstances under which tests are performed to determine which drugs are present, might vary by jurisdiction and over time. Second, the percentage of deaths with specific drugs identified on the death certificate varies by jurisdiction and over time. Nationally, 19% (in 2014) and 17% (in 2015) of drug overdose death certificates did not include the specific types of drugs involved. Additionally, the percentage of drug overdose deaths with specific drugs identified on the death certificate varies widely by state, ranging from 47.4% to 99%. Variations in reporting across states prevent comparison of rates between states. Third, improvements in testing and reporting of specific drugs might have contributed to some observed increases in opioid-involved death rates. Fourth, because heroin and morphine are metabolized similarly (9), some heroin deaths might have been misclassified as morphine deaths, resulting in underreporting of heroin deaths. Finally the state-specific analyses of opioid deaths are restricted to 28 states, limiting generalizability."

"Preliminary estimates of U.S. drug overdose deaths exceeded 60,000 in 2016 and were partially driven by a fivefold increase in overdose deaths involving synthetic opioids (excluding methadone), from 3,105 in 2013 to approximately 20,000 in 2016 (1,2). Illicitly manufactured fentanyl, a synthetic opioid 50–100 times more potent than morphine, is primarily responsible for this rapid increase (3,4). In addition, fentanyl analogs such as acetylfentanyl, furanylfentanyl, and carfentanil are being detected increasingly in overdose deaths (5,6) and the illicit opioid drug supply (7). Carfentanil is estimated to be 10,000 times more potent than morphine (8). Estimates of the potency of acetylfentanyl and furanylfentanyl vary but suggest that they are less potent than fentanyl (9). Estimates of relative potency have some uncertainty because illicit fentanyl analog potency has not been evaluated in humans."

The White House Council of Economic Advisers [CEA] released its analysis of the economic costs of illegal opioid use, related overdoses, and overdose mortality in November 2017. It reported a dramatically higher estimate than previous analyses, largely due to a change in methodology. Previous analyses had used a person's estimated lifetime earnings to place a dollar value on that person's life. According to the CEA, "We diverge from the previous literature by quantifying the costs of opioid-related overdose deaths based on economic valuations of fatality risk reduction, the “value of a statistical life” (VSL)."

The CEA noted that "According to a recent white paper prepared by the U.S. Environmental Protection Agency’s (EPA) Office of Policy for review by the EPA’s Science Advisory Board (U.S. EPA 2016), the EPA’s current guidance calls for using a VSL estimate of $10.1 million (in 2015 dollars), updated from earlier estimates based on inflation, income growth, and assumed income elasticities. Guidance from the U.S. Department of Health and Human Services (HHS) suggests using the range of estimates from Robinson and Hammitt (2016) referenced earlier, ranging from a low of $4.4 million to a high of $14.3 million with a central value of $9.4 million (in 2015 dollars). The central estimates used by these three agencies, DOT, EPA, and HHS, range from a low of $9.4 million (HHS) to a high of $10.1 million (EPA) (in 2015 dollars)."

In addition, the CEA assumed that the number of opioid-related overdoses in the US in 2015 was significantly under-reported. According to its report, "However, recent research has found that opioids are underreported on death certificates. Ruhm (2017) estimates that in 2014, opioid-involved overdose deaths were 24 percent higher than officially reported.4 We apply this adjustment to the 2015 data, resulting in an estimated 41,033 overdose deaths involving opioids. We apply this adjustment uniformly over the age distribution of fatalities."

The combination of that assumption with the methodology change resulted in a dramatically higher cost estimate than previous research had shows. According to the CEA, "CEA’s preferred cost estimate of $504.0 billion far exceeds estimates published elsewhere. Table 3 shows the cost estimates from several past studies of the cost of the opioid crisis, along with the ratio of the CEA estimate to each study’s estimate in 2015 dollars. Compared to the recent Florence et al. (2016) study—which estimated the cost of prescription opioid abuse in 2013—CEA’s preferred estimate is more than six times higher, reported in the table’s last column as the ratio of $504.0 billion to $79.9 billion, which is Florence et al.’s estimate adjusted to 2015 dollars. Even CEA’s low total cost estimate of $293.9 billion is 3.7 times higher than Florence et al.’s estimate."

In contrast, the CEA noted that "Among the most recent (and largest) estimates was that produced by Florence et al. (2016), who estimated that prescription opioid overdose, abuse, and dependence in the United States in 2013 cost $78.5 billion. The authors found that 73 percent of this cost was attributed to nonfatal consequences, including healthcare spending, criminal justice costs and lost productivity due to addiction and incarceration. The remaining 27 percent was attributed to fatality costs consisting almost entirely of lost potential earnings." According to the CDC, there were 25,840 deaths in 2013 related to an opioid overdose.

According to the CEA, "We also present cost estimates under three alternative VSL assumptions without age-adjustment: low ($5.4 million), middle ($9.6 million), and high ($13.4 million), values suggested by the U.S. DOT and similar to those used by HHS. For example, our low fatality cost estimate of $221.6 billion is the product of the adjusted number of fatalities, 41,033, and the VSL assumption of $5.4 million. Our fatality cost estimates thus range from a low of $221.6 billion to a high of $549.8 billion."

"The Underestimated Cost of the Opioid Crisis," Council of Economic Advisers, Executive Office of the President of the United States, November 2017.https://www.whitehouse.gov/sit...
Warner M, Trinidad JP, Bastian BA, et al. Drugs most frequently involved in drug overdose deaths: United States, 2010–2014. National vital statistics reports; vol 65 no 10. Hyattsville, MD: National Center for Health Statistics. 2016. Table B, p. 64.https://www.cdc.gov/nchs/data/...https://www.cdc.gov/nchs/produ...

"In 2016, a total of 67,265 persons died of drug-induced causes in the United States (Tables 5, 6, 8, and I–1). This category includes deaths from poisoning and medical conditions caused by use of legal or illegal drugs, as well as deaths from poisoning due to medically prescribed and other drugs. It excludes deaths indirectly related to drug use, as well as newborn deaths due to the mother's drug use. (For a list of drug-induced causes, see Technical Notes.)

"In 2016, the age-adjusted death rate for drug-induced causes for the total population increased significantly, by 20.9% from 17.2 in 2015 to 20.8 in 2016 (Tables 5, 10, and I–1). For males in 2016, the age-adjusted death rate for drug-induced causes was 1.9 times the rate for females. The rate for drug-induced causes increased 26.0% for males and 13.6% for females in 2016 from 2015. The age-adjusted death rate for non-Hispanic white males was 28.9% higher than for non-Hispanic black males and 131.8% higher than for Hispanic males. The rate for non-Hispanic white females was 71.6% higher than for non-Hispanic black females and 252.8% higher than for Hispanic females.

"Of the 36,667 drug overdose deaths with at least one mention of a specific drug, 52% mentioned only one specific drug (18,931 deaths), 26% mentioned two (9,351 deaths), 12% mentioned three (4,521 deaths), 6% mentioned four (2,041 deaths), and 5% mentioned five or more (1,823 deaths). Among drug overdose deaths with at least one mention of a specific drug, the average number of specific drugs mentioned was 1.9.

"Table C shows the percentage of drug overdose deaths with concomitant drugs for drug overdose deaths involving the top 10 drugs in 2014. The percentage of deaths involving concomitant drugs varied by referent drug. For example, the majority of the drug overdose deaths involving methamphetamine did not involve other drugs. In contrast, among deaths involving alprazolam and diazepam, more than 95% involved other drugs.

"The average number of concomitant drugs involved (excluding the referent drug) also varied among the top 10 drugs involved in drug overdose deaths. For example, drug overdose deaths involving diazepam or alprazolam had on average more than two additional drugs involved in death. Drug overdose deaths involving fentanyl, heroin, cocaine, or methamphetamine had on average fewer than two additional drugs involved in death.

"Figure 5 shows the percent distribution of the number of concomitant drugs for overdose deaths involving the top 10 drugs in 2014 (Table 5). For example, for drug overdose deaths involving methamphetamine, 55% had no concomitant mentions, 25% mentioned one other drug, 18% mentioned two to four other drugs, and 1% mentioned five or more drugs. In contrast, for drug overdose deaths involving diazepam, 3% had no concomitant mentions, 22% mentioned one other drug, 62% mentioned two to four other drugs, and 13% mentioned five or more other drugs.

"Table D shows the most frequent concomitant drugs for each of the top 10 drugs involved in drug overdose deaths in 2014.

" One in five drug overdose deaths involving heroin also involved cocaine.
" Alprazolam was involved in 26% of the drug overdose deaths involving hydrocodone, 23% of the deaths involving oxycodone, and 18% of the deaths involving methadone.
" More than one-third (37%) of the drug overdose deaths involving cocaine also involved heroin.
" Nearly 20% of the overdose deaths involving methamphetamine also involved heroin."

"In 2016, a total of 34,865 persons died of alcohol-induced causes in the United States (Tables 5, 6, 8, and I–2). This category includes deaths from dependent and nondependent use of alcohol, as well as deaths from accidental poisoning by alcohol. It excludes unintentional injuries, homicides, and other causes indirectly related to alcohol use, as well as deaths due to fetal alcohol syndrome. For a list of alcohol-induced causes, see Technical Notes.

"The age-adjusted death rate for alcohol-induced causes for the total population increased significantly, by 4.4% from 9.1 in 2015 to 9.5 in 2016 (Tables 5, 10, and I–2). For males, the age-adjusted death rate for alcohol-induced causes in 2016 was 2.7 times the rate for females. The rate for alcohol-induced causes increased 3.7% for males and 4.0% for females in 2016 from 2015. The age-adjusted death rate for non-Hispanic white males was 32.1% higher than for non-Hispanic black males and 16.3% lower than for Hispanic males. The rate for non-Hispanic white females was 66.7% higher than for non-Hispanic black females and 62.2% higher than for Hispanic females.

"Among the major race–ethnicity–sex groups, the age- adjusted rate for alcohol-induced death increased significantly in 2016 from 2015 for non-Hispanic white males (4.3%) and non-Hispanic white females (7.1%). The rates for non-Hispanic black males, non-Hispanic black females, Hispanic males, and Hispanic females did not change significantly."

"In 2014, alcohols, including ethanol and isopropyl alcohol, were involved in 15% of all drug overdose deaths and 17% of the drug overdose deaths that mentioned involvement of at least one specific drug. Table E shows the frequency of alcohol involvement among drug overdose deaths involving specific drugs.

"On average, 6 people died every day from alcohol poisoning in the US from 2010 to 2012. Alcohol poisoning is caused by drinking large quantities of alcohol in a short period of time. Very high levels of alcohol in the body can shutdown critical areas of the brain that control breathing, heart rate, and body temperature, resulting in death. Alcohol poisoning deaths affect people of all ages but are most common among middle-aged adults and men."

"The 2014 Surgeon General's report estimates that cigarette smoking causes more than 480,000 deaths each year in the United States.1 This widely cited estimate of the mortality burden of smoking may be an underestimate, because it considers deaths only from the 21 diseases that have been formally established as caused by smoking (12 types of cancer, 6 categories of cardiovascular disease, diabetes, chronic obstructive pulmonary disease [COPD], and pneumonia including influenza). Associations between smoking and the 30 most common causes of death in the United Kingdom in the Million Women Study suggest that the excess mortality observed among current smokers cannot be fully explained by these 21 diseases.2

"Our results suggest that the Surgeon General's recent estimate of smoking-attributable mortality may have been an underestimate. The Surgeon General's estimate, which took into account only the 21 diseases formally established as caused by smoking, was that approximately 437,000 deaths among adults are caused each year by active smoking (not including secondhand smoke). However, the Surgeon General’s report presents an alternative estimate of 556,000 deaths among adults on the basis of the excess mortality from all causes. The difference between these two estimates is nearly 120,000 deaths.1 If, as suggested by the results in our cohort, at least half of this difference is due to associations of smoking with diseases that are causal but are not yet formally established as such, then at least 60,000 additional deaths each year among U.S. men and women may be caused by cigarette smoking."

"In 2013, a total of 43,982 deaths in the United States were attributed to drug poisoning, including 16,235 deaths (37%) involving opioid analgesics. From 1999 to 2013, the drug poisoning death rate more than doubled from 6.1 to 13.8 per 100,000 population, and the rate for drug poisoning deaths involving opioid analgesics nearly quadrupled from 1.4 to 5.1 per 100,000. For both drug poisoning and drug poisoning involving opioid analgesics, the death rate increased at a faster pace from 1999 to 2006 than from 2006 to 2013."

"In 2011, 5,188 opioid-analgesic poisoning deaths also involved benzodiazepines (sedatives used to treat anxiety, insomnia, and seizures), up from 527 such deaths in 1999 (Figure 3). From 2006 through 2011, the number of opioid-analgesic poisoning deaths involving benzodiazepines increased 14% on average each year, while the number of opioid-analgesic poisoning deaths not involving benzodiazepines did not change significantly."

"Opioids were frequently implicated in overdose deaths involving other pharmaceuticals. They were involved in the majority of deaths involving benzodiazepines (77.2%), antiepileptic and antiparkinsonism drugs (65.5%), antipsychotic and neuroleptic drugs (58.0%), antidepressants (57.6%), other analgesics, antipyretics, and antirheumatics (56.5%), and other psychotropic drugs (54.2%). Among overdose deaths due to psychotherapeutic and central nervous system pharmaceuticals, the proportion involving only a single class of such drugs was highest for opioids (4903/16 651; 29.4%) and lowest for benzodiazepines (239/6497; 3.7%)."

"Over the 15-year study period, 335,123 opioid-related deaths in the United States met our inclusion criteria, with an increase of 345% from 9489 in 2001 (33.3 deaths per million population) to 42,245 in 2016 (130.7 deaths per million population). By 2016, men accounted for 67.5% of all opioid-related deaths (n = 28,496), and the median (interquartile range) age at death was 40 (30-52) years. The proportion of deaths attributable to opioids increased over the study period, rising 292% (from 0.4% [1 in 255] to 1.5% [1 in 65]), and increased steadily over time in each age group studied (P < .001 for all age groups) (Figure). The largest absolute increase between 2001 and 2016 was observed among those aged 25 to 34 years (15.8% increase from 4.2% in 2001 to 20.0% in 2016), followed by those aged 15 to 24 years (9.4% increase from 2.9% to 12.4%). However, the largest relative increases occurred among adults aged 55 to 64 years (754% increase from 0.2% to 1.7%) and those aged 65 years and older (635% increase from 0.01% to 0.07%). Despite the fact that confirmed opioid-related deaths represent a small percentage of all deaths in these older age groups, the absolute number of deaths is moderate. In 2016, 18.4% (7762 of 42,245) of all opioid-related deaths in the United States occurred among those aged 55 years and older.

"In our analysis of the burden of early loss of life from opioid overdose, we found that opioid-related deaths were responsible for 1,681,359 YLL [Years of Life Lost] (5.2 YLL per 1000 population) in the United States in 2016 (Table); however, this varied by age and sex. In particular, when stratified by age, adults aged 25 to 34 years and those aged 35 to 44 years experienced the highest burden from opioid-related deaths (12.9 YLL per 1000 population and 9.9 YLL per 1000 population, respectively). We also found that the burden of opioid-related death was higher among men (1,125,711 YLL; 7.0 YLL per 1000 population) compared with women (555,648 YLL; 3.4 YLL per 1000 population). Importantly, among men aged 25 to 34 years, this rate increased to 18.1 YLL per 1000 population, and the total YLL in this population represented nearly one-quarter of all YLL in the United States in 2016 (411,805 of 1,681,359 [24.5%])."

"This analysis confirms the predominant role opioid analgesics play in pharmaceutical overdose deaths, either alone or in combination with other drugs. It also, however, highlights the frequent involvement of drugs typically prescribed for mental health conditions such as benzodiazepines, antidepressants, and antipsychotics in overdose deaths. People with mental health disorders are at increased risk for heavy therapeutic use, nonmedical use, and overdose of opioids.4-6 Screening, identification, and appropriate management of such disorders is an important part of both behavioral health and chronic pain management."

"From 1999 to 2007, the number of U.S. poisoning deaths involving any opioid analgesic (e.g., oxycodone, methadone, or hydrocodone) more than tripled, from 4,041 to 14,459, or 36% of the 40,059 total poisoning deaths in 2007. In 1999, opioid analgesics were involved in 20% of the 19,741 poisoning deaths. During 1999–2007, the number of poisoning deaths involving specified drugs other than opioid analgesics increased from 9,262 to 12,790, and the number involving nonspecified drugs increased from 3,608 to 8,947."

"In summary, this study showed little, if any, effect of marijuana use on non-AIDS mortality in men and on total mortality in women. The increased risk of AIDS mortality in male marijuana users probably did not reflect a causal relationship, but most likely represented uncontrolled confounding by male homosexual behavior. The risk of mortality associated with marijuana use was lower than that associated with tobacco cigarette smoking."

"Hall and Henry (2006) reviewed the medical scenarios and treatment options for physicians dealing with MDMA-related medical emergencies: ‘Hyperpyrexia and multi-organ failure are now relatively well-known, other serious effects have become apparent more recently. Patients with acute MDMA toxicity may present to doctors working in Anaesthesia, Intensive Care, and Emergency Medicine. A broad knowledge of these pathologies and their treatment is necessary for those working in an acute medicine speciality’.
"Despite rapid medical intervention, some disorders are difficult to reverse and deteriorate rapidly, with occasional fatal outcomes (Schifano et al., 2003). In an early report, Henry et al. (1992) described MDMA-induced fatalities in seven young party goers, whose body temperatures at the intensive care unit ranged between 40

"During 1999–2008, overdose death rates, sales, and substance abuse treatment admissions related to OPR increased in parallel (Figure 2). The overdose death rate in 2008 was nearly four times the rate in 1999. Sales of OPR in 2010 were four times those in 1999."

"Schifano et al. (2010) analysed the government data on recreational stimulant deaths in the UK between 1997 and 2007. Over this period, there were 832 deaths related to amphetamine or methamphetamine and 605 deaths related to Ecstasy/MDMA. Many were related to multiple-drug ingestion or ‘polydrug’ use. However, in the analysis of ‘mono-intoxication’ fatalities, Schifano et al. (2010) found that deaths following Ecstasy use were significantly more represented than deaths following amphetamine/methamphetamine use (p < 0.007)."

"In 2008, a total of 36,450 deaths were attributed to drug overdose, a rate of 11.9 per 100,000 population (Table 1), among which a drug was specified in 27,153 (74.5%) deaths. One or more prescription drugs were involved in 20,044 (73.8%) of the 27,153 deaths, and OPR were involved in 14,800 (73.8%) of the 20,044 prescription drug overdose deaths."

"The lethal dose of alcohol divided by a typical recreational dose (safety ratio) is 10, which places it closer to heroin (6), and GHB (8) in terms of danger from overdose, than MDMA ('Ecstasy' – 16), and considerably more dangerous than LSD (1000) or cannabis (>1000)."

Sellman, Doug, "If alcohol was a new drug," Journal of the New Zealand Medical Association (Wellington, New Zealand: New Zealand Medical Association, September 2009), p. 6.http://www.nzma.org.nz/__data/...

"Although the mean annual opioid analgesic overdose mortality rate was lower in states with medical cannabis laws compared with states without such laws, the findings of our secondary analyses deserve further consideration. State-specific characteristics, such as trends in attitudes or health behaviors, may explain variation in medical cannabis laws and opioid analgesic overdose mortality, and we found some evidence that differences in these characteristics contributed to our findings. When including state-specific linear time trends in regression models, which are used to adjust for hard-to-measure confounders that change over time, the association between laws and opioid analgesic overdose mortality weakened. In contrast, we did not find evidence that states that passed medical cannabis laws had different overdose mortality rates in years prior to law passage, providing a temporal link between laws and changes in opioid analgesic overdose mortality. In addition, we did not find evidence that laws were associated with differences in mortality rates for unrelated conditions (heart disease and septicemia), suggesting that differences in opioid analgesic overdose mortality cannot be explained by broader changes in health. In summary, although we found a lower mean annual rate of opioid analgesic mortality in states with medical cannabis laws, a direct causal link cannot be established."

"Excessive alcohol use* accounted for an estimated average of 80,000 deaths and 2.3 million years of potential life lost (YPLL) in the United States each year during 2001–2005, and an estimated $223.5 billion in economic costs in 2006. Binge drinking accounted for more than half of those deaths, two thirds of the YPLL, and three quarters of the economic costs."

* Excessive alcohol use includes binge drinking (defined by CDC as consuming four or more drinks per occasion for women or five or more drinks per occasion for men), heavy drinking (defined as consuming more than one drink per day on average for women or more than two drinks per day on average for men), any alcohol consumption by pregnant women, and any alcohol consumption by youths aged less than 21 years.

"Overall, we found that alcohol use accounted for approximately 3.5% of all cancer deaths, or about 19 500 persons, in 2009. It was a prominent cause of premature loss of life, with each alcohol-attributable cancer death resulting in about 18 years of potential life lost. Although cancer risks were greater and alcohol-attributable cancer deaths more common among persons who consumed an average of more than 40 grams of alcohol per day (‡ 3 drinks), approximately 30% of alcohol-attributable cancer deaths occurred among persons who consumed 20 grams or less of alcohol per day. About 15% of breast cancer deaths among women in the United States were attributable to alcohol consumption."

"Our estimate of 19,500 alcohol-related cancer deaths is greater than the total number of deaths from some types of cancer that receive much more prominent attention, such as melanoma or ovarian cancer,36 and it amounted to more than two thirds of all prostate cancer deaths in 2009.36 Reducing alcohol consumption is an important and underemphasized cancer prevention strategy, yet receives surprisingly little attention among public health, medical, cancer, advocacy, and other organizations in the United States, especially when compared with efforts related to other cancer prevention topics such as screening, genetics, tobacco, and obesity."

"The age-adjusted death rate increased significantly between 2013 and 2014 for five leading causes: unintentional injuries (2.8%), stroke (0.8%), Alzheimer’s disease (8.1%), suicide (3.2%), and Chronic liver disease and cirrhosis (2.0%)."
According to the CDC, there were 42,773 deaths by suicide in the United States in 2014.

"Assault (homicide), the 17th leading cause of death in 2014, dropped from among the 15 leading causes of death in 2010 but is still a major issue for some age groups. In 2014, homicide remained among the 15 leading causes of death for age groups 1–4 (3rd), 5–14 (5th), 15–24 (3rd), 25–34 (3rd), 35–44 (5th), and 45–54 (13th)."
According to the CDC, there were a total of 15,809 deaths by assault (homicide) in the US in 2014.

"UNODC estimates that there were between 102,000 and 247,000 drug-related deaths in 2011, corresponding to a mortality rate of between 22.3 and 54.0 deaths per million population aged 15-64. This represents between 0.54 per cent and 1.3 per cent of mortality from all causes globally among those aged 15-64.20 The extent of drug-related deaths has essentially remained unchanged globally and within regions."

"On average, 6 people died every day from alcohol poisoning in the US from 2010 to 2012. Alcohol poisoning is caused by drinking large quantities of alcohol in a short period of time. Very high levels of alcohol in the body can shutdown critical areas of the brain that control breathing, heart rate, and body temperature, resulting in death. Alcohol poisoning deaths affect people of all ages but are most common among middle-aged adults and men."

The Centers for Disease Control reported that in 2008, HIV disease was the 25th leading cause of death in the US for non-Hispanic whites, the 10th leading cause of death for non-Hispanic blacks, and the 17th leading cause of death for Hispanics.

"Illicit drug use is associated with suicide, homicide, motor-vehicle injury, HIV infection, pneumonia, violence, mental illness, and hepatitis. An estimated 3 million individuals in the United States have serious drug problems. Several studies have reported an undercount of the number of deaths attributed to drugs by vital statistics; however, improved medical treatments have reduced mortality from many diseases associated with illicit drug use. In keeping with the report by McGinnis and Foege, we included deaths caused indirectly by illicit drug use in this category. We used attributable fractions to compute the number of deaths due to illicit drug use. Overall, we estimate that illicit drug use resulted in approximately 17000 deaths in 2000, a reduction of 3000 deaths from the 1990 report."

"The global average homicide rate stands at 6.2 per 100,000 population, but Southern Africa and Central America have rates over four times higher than that (above 24 victims per 100,000 population), making them the sub-regions with the highest homicide rates on record, followed by South America, Middle Africa and the Caribbean (between 16 and 23 homicides per 100,000 population). Meanwhile, with rates some five times lower than the global average, Eastern Asia, Southern Europe and Western Europe are the sub-regions with the lowest homicide levels.
"Almost three billion people live in an expanding group of countries with relatively low homicide rates, many of which, particularly in Europe and Oceania, have continued to experience a decrease in their homicide rates since 1990. At the opposite end of the scale, almost 750 million people live in countries with high homicide levels, meaning that almost half of all homicides occur in countries that make up just 11 per cent of the global population and that personal security is still a major concern for more than 1 in 10 people on the planet."

"The leading causes of death in 2000 were tobacco (435,000 deaths; 18.1% of total US deaths), poor diet and physical inactivity (400,000 deaths; 16.6%), and alcohol consumption (85,000 deaths; 3.5%). Other actual causes of death were microbial agents (75,000), toxic agents (55,000), motor vehicle crashes (43,000), incidents involving firearms (29,000), sexual behaviors (20,000), and illicit use of drugs (17,000)."

Note: According to a correction published by the Journal on January 19, 2005, "On page 1240, in Table 2, '400,000 (16.6)' deaths for 'poor diet and physical inactivity' in 2000 should be '365,000 (15.2).' A dagger symbol should be added to 'alcohol consumption' in the body of the table and a dagger footnote should be added with 'in 1990 data, deaths from alcohol-related crashes are included in alcohol consumption deaths, but not in motor vehicle deaths. In 2000 data, 16,653 deaths from alcohol-related crashes are included in both alcohol consumption and motor vehicle death categories."

"Each year offers new examples of injuries and deaths caused by untoward dangers in prescription drugs. Prominent illustrations from recent years include Vioxx, a popular arthritis painkiller that more than doubled the risk of heart attacks and strokes,6 a risk that lingered long after users stopped taking the drug;7 'Phen-fen,' a diet drug that caused heart damage;8 and Propulsid, a drug that reduced gastric acid but also threatened patients’ hearts.9 Once information on these side-effects became known to the public, the manufacturers of each of these drugs stopped selling them and, eventually, paid millions or billions of dollars to settle claims for resulting injuries.10 Merck, for example, having withdrawn the profitable Vioxx drug11 from the market in 2004, settled nearly 50,000 Vioxx cases in late 2007 for $4.85 billion.12 In 2009, Eli Lilly agreed to plead guilty and pay $1.415 billion in criminal and civil penalties for promoting its antipsychotic drug, Zyprexa, as suitable for uses not approved by the Food and Drug Administration (“FDA”).13 These cases may be among the more prominent, but they represent just the tip of the iceberg of damage caused by prescription drugs."

Owen, David G., "Dangers in Prescription Drugs: Filling a Private Law Gap in the Healthcare Debate," Connecticut Law Review (Hartford, CT: University of Connecticut School of Law, February 2010) Volume 42, Number 3, p. 737.http://uconn.lawreviewnetwork....

"Adverse drug reactions are a significant public health problem in our health care system. For the 12,261,737 Medicare patients admitted to U.S. hospitals, ADRs were projected to cause the following increases: 2976 deaths, 118,200 patient-days, $516,034,829 in total charges, $37,611,868 in drug charges, and $9,456,698 in laboratory charges. If all Medicare patients were considered, these figures would be 3 times greater."

"3. The most obvious concern when dealing with drug safety is the possibility of lethal effects. Can the drug cause death?
"4. Nearly all medicines have toxic, potentially lethal effects. But marijuana is not such a substance. There is no record in the extensive medical literature describing a proven, documented cannabis-induced fatality.
"5. This is a remarkable statement. First, the record on marijuana encompasses 5,000 years of human experience. Second, marijuana is now used daily by enormous numbers of people throughout the world. Estimates suggest that from twenty million to fifty million Americans routinely, albeit illegally, smoke marijuana without the benefit of direct medical supervision. Yet, despite this long history of use and the extraordinarily high numbers of social smokers, there are simply no credible medical reports to suggest that consuming marijuana has caused a single death.
"6. By contrast aspirin, a commonly used, over-the-counter medicine, causes hundreds of deaths each year.
"7. Drugs used in medicine are routinely given what is called an LD-50. The LD-50 rating indicates at what dosage fifty percent of test animals receiving a drug will die as a result of drug induced toxicity. A number of researchers have attempted to determine marijuana's LD-50 rating in test animals, without success. Simply stated, researchers have been unable to give animals enough marijuana to induce death.
"8. At present it is estimated that marijuana's LD-50 is around 1:20,000 or 1:40,000. In layman terms this means that in order to induce death a marijuana smoker would have to consume 20,000 to 40,000 times as much marijuana as is contained in one marijuana cigarette. NIDA-supplied marijuana cigarettes weigh approximately .9 grams. A smoker would theoretically have to consume nearly 1,500 pounds of marijuana within about fifteen minutes to induce a lethal response.
"9. In practical terms, marijuana cannot induce a lethal response as a result of drug-related toxicity."

"Our study revealed that experiencing an ADR [Adverse Drug Reaction] while hospitalized substantially increased the risk of death (1971 excess deaths, OR 1.208, 95% CI 1.184-1.234). This finding reflects about a 20% increase in mortality associated with an ADR in hospitalized patients. Extrapolating this finding to all patients suggests that 2976 Medicare patients/year and 8336 total patients/year die in U.S. hospitals as a direct result of ADRs; this translates to approximately 1.5 patients/hospital/year."

"Each year, use of NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) accounts for an estimated 7,600 deaths and 76,000 hospitalizations in the United States." (NSAIDs include aspirin, ibuprofen, naproxen, diclofenac, ketoprofen, and tiaprofenic acid.)

"The most toxic recreational drugs, such as GHB (gamma-hydroxybutyrate) and heroin, have a lethal dose less than 10 times their typical effective dose. The largest cluster of substances has a lethal dose that is 10 to 20 times the effective dose: These include cocaine, MDMA (methylenedioxymethamphetamine, often called 'ecstasy') and alcohol. A less toxic group of substances, requiring 20 to 80 times the effective dose to cause death, include Rohypnol (flunitrazepam or 'roofies') and mescaline (peyote cactus). The least physiologically toxic substances, those requiring 100 to 1,000 times the effective dose to cause death, include psilocybin mushrooms and marijuana, when ingested. I’ve found no published cases in the English language that document deaths from smoked marijuana, so the actual lethal dose is a mystery."